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TREASURY DEPARTMENT 
UNITED STATES PUBLIC HEALTH SERVICE 

HUGH S. CUMMING, Surgeon General 



SICKNESS AMONG SCHOOL 
CHILDREN 



LOSS OF TIME FROM SCHOOL AMONG 

6,130 SCHOOL CHILDREN IN 13 

LOCALITIES IN MISSOURI 



BY 

SELWYN D. COLLINS 

ii 

Assistant Statistician 
United States Public Health Service 



REPRINT No. 674 

FROM THE 

PUBLIC HEALTH REPORTS 

July 8, 1921 
(Pages 1549-1559) 



2|-24^ri 




WASHINGTON 
GOVERNMENT PRINTING OFFICE 

1921 



MOiKtf. 



\». 






SICKNESS AMONG SCHOOL CHILDREN. 

Loss of Time From School Among 6,130 School Children in 13 Localities in Missouri. 1 

By Selv?tn D. Collins, Assistant Statistician, United States Public Health Service. 

At the present stage of our knowledge of disease problems, any 
records which show the true incidence of even a few diseases in an 
observed population are important. Ordinary morbidity reports as 
furnished by physicians to local health departments do not, for well- 
known reasons, give an accurate picture of the incidence of any 
disease in a definitely enumerated population group. It is necessary, 
therefore, to utilize other methods for obtaining the desired informa- 
tion. 

In a general way, the most promising directions for seeking data 
of this character are: (1) Records of disability among groups of in- 
sured persons associated in various kinds of sick-benefit associations; 
(2) records of sickness in groups of persons employed in industrial 
establishments where careful medical supervision and a system of 
disability records have been established; (3) records of sickness in 
groups of individuals living in institutions or attending school; and 
(4) special surveys of population groups made for the specific purpose 
of ascertaining the incidence of a given disease or group of diseases. 

In various prior publications the Public Health Service has pre- 
sented statistics of disability among adult wage earners who are mem- 
bers of sick-benefit associations, and the results of special sickness 
surveys. In the hope of obtaining data regarding the incidence of 
diseases among children, an attempt was made in connection with 
the field studies in child hygiene in Missouri during 1919-20, to insti- 
tute a system of sickness records in connection with the schools. 
This was undertaken purely as an experiment, and a limited number 
of schools were requested to cooperate with the Public Health Service 
for this purpose. The results are presented in the following pages. 
The work is being undertaken on a larger scale, not only in Missouri 
but in other States for the school session of 1921-22. 

The data here presented were collected in 13 localities in the State 
of Missouri. These data were entered by the teachers on cards dis- 

i from Field Investigations in Child Hygiene, United States Public Health Service. The statistical 
part of this study was conducted in the Statistical Office of the Public Health Service. Reprint from the 
Public Health Reports, vol. 36, No. 27, July 8, 1921, pp. 1549-1559. 
9 



63631°— 21 



LIBRARY Of C0N3RI88 
JK&ilVID 

0OOUMENT8 Dl i idlQN 



SICKNESS AMONG SCHOOL CHILDREN. 6 

tributed by medical officers of the Public Health Service in charge of 
child hygiene studies in the several communities. A card was made 
out for each child, showing sex, color, and age, and record, by school 
months, of the total possible number of days of school attendance, 1 
the days present, the days absent on account of sickness, and the 
days absent from causes other than sickness. The card also con- 
tained a record of the diseases the child had during each month of 
the session. 

After the cards had been completed and collected, they were care- 
fully edited for errors, and only those which seemed to be properly 
and accurately used were included in the tabulation. It is believed 
that the necessary selection of properly filled out cards did not elimi- 
nate a disproportionate number of any particular class, such as those 
showing an excessive amount of absence or attendance. 

The records, even after careful editing, however, can be consid- 
ered only as 9 preliminary experiment. The data were incomplete 
in many ways. Records showing the specific data desired on the 
card were kept only after the first of the year 1920, and in some 
localities they were begun even later. Data for the months prior 
to the beginning of any special records were taken from the 
regular school records and, therefore, vary in completeness in 
the different localities. The entries showing the specific diseases 
causing the absence were not complete; in the majority of cases the 
number of days absent because of sickness was shown without speci- 
fying the disease. It was therefore decided to compute only the per- 
centages of the total possible days of school attendance which were 
lost on account of sickness of all kinds and of causes other than sick- 
ness, with certain other data based on those cards reporting the spe- 
cific disease causing the absence. 

Table I shows the size and location of the cities from which data 
were drawn. They range from one to twenty thousand in population, 
and are fairly representative, average-sized cities of the State. No 
data from the larger cities were included. 

1 It was found that, according to the prevailing custom in keeping school records of enrollment, a child's 
name was dropped from the roll after three days' absence and reentered when he returned. In tabulating 
the records for the purpose of counting the absence from school on account of sickness, a child's name was 
not dropped from the roll except when he was permanently separated from the school, as in the case of a 
child who left the community, or who went to work, or some similar case. With this difference, the total 
possible number of days of school attendance is the total number of days enrolled during the period used 
for the computation. 



SICKNESS AMONG SCHOOL CHILDREN. 



Table I. — Population and location of certain cities in Missouri and the number of chil- 
dren for whom, sickness records were obtained in each place. 



City. 



County. 



Popula- 
tion of 
city. 1920. 



Number 

of 
children 
included. 



Sedalia Pettis . 

Jellerson City Cole. 

Independence 

Cape Girardeau 

Warrensburg 

Excelsior Springs 

Bonne Terre 

West Plains 

Liberty 

Farmington 

Jackson 

Montgomery 

Oregon 



Jackson 

Cape Girardeau. 

Johnson 

Clay 

St. Francis 

Howell 

Clay 

St. Francis 

Cape Girardeau . 
Montgomery 
Holt 



21,144 

14,490 

11,686 

10, 252 

4, Ml 

4,165 

3,*15 

3,178 

3,097 

2,685 

2,114 

1,68S 

904 



1,367 
660 
969 
230 
446 
302 
641 
436 
351 
421 
154 
16 
137 



Table II, computed from the basic data shown in Table VII (see 
appended tables), shows by months the percentages of the total 
possible number of days of school attendance whiqji were lost on 
account of sickness and of causes other than sickness. The data 
are shown by sex and for two age groups. 

Table II. — Percentages of total possible number of days of school attendance which wext 
lost on account of sickness and of causes other than sickness for each month of the school 
year 1919-20, in certain localities in Missouri. 









1919 








1920 






Cause of absence, 


Total 






































sex, and age group. 


year. 


Septem- 
ber. 


Octo- 
ber. 


Novem- 
ber. 


Decem- 
ber. 


Janu- 
ary. 


Febru- 
ary. 


March. 


April. 


May. 


Sickness: 






















Both sexes- 






















All ages (6 






















to 18) 


5.6 


1.3 


2.5 


4.2 


5.5 


6.3 


11.6 


6.9 


5.8 


3.6 


6tol0 


6.9 


1.3 


3.0 


5.4 


6.7 


7.5 


13.9 


8.9 


7.6 


4.7 


11 to 18) 


4.1 


1.3 


2.0 


2.9 


4.2 


4.9 


9.0 


4.7 


4.0 


2.4 


Boys- 






















All ages (6 






















to 18) 


5.4 


1.2 


2.3 


4.0 


4.8 


6.1 


11.9 


6.6 


5.8 


3.2 


6tol0 


6.7 


1.2 


2.7 


5.0 


5.7 


7.4 


14.0 


8.7 


7.5 


4.1 


11 to 18 


3.9 


1.2 


2.0 


3.0 


3.8 


4.5 


9.5 


4.3 


3.8 


2.3 


Girls- 






















All ages (6 






















to 18) 


5.8 


1.4 


2.7 


4.4 


6.2 


6.6 


11.4 


7.2 


5.9 


4.0 


6tol0 


7.2 


1.4 


3.3 


5.8 


7.6 


7.7 


13.8 


9.1 


7.7 


5.3 


11 to 18 


4.2 


1.4 


1.9 


2.9 


4.6 


5.3 


8.6 


5.1 


4.1 


2.6 


Other causes: 






















Both sexes- 






















All ages (6 






















to 18) 


3.0 


2.0 


2.5 


2.6 


3.3 


3.1 


4.0 


3.2 


2.9 


2.7 


6 to 10 


2.9 


2.2 


2.8 


2.6 


3.4 


3.3 


3.9 


2.8 


2.5 


2.6 


11 to 18 


3.1 


1.9 


2.2 


2.6 


3.2 


3.0 


4.1 


3.6 


3.3 


2.8 


Boys- 






















All ages (6 






















to 18) 


3.2 


2.2 


2.8 


2.6 


3.7 


3.4 


4.4 


3.5 


3.1 


3.1 


6tol0 


3.1 


2.2 


3.2 


2.7 


3.8 


3.6 


4.3 


3.0 


2.6 


2.8 


11 to 18 


3.4 


2.2 


2.3 


2.6 


3.6 


3.1 


4.6 


4.0 


3.8 


3.4 


Girls- 






















All ages (6 






















to 18) 


2.7 


1.9 


2.2 


2.5 


2.9 


2.9 


3.6 


2.9 


2.6 


2.3 


6tol0 


2.6 


2.2 


2.3 


2.5 


3.0 


3.0 


3.5 


2.6 


2.4 


2.3 


11 to 18. .. 


2.7 


1.5 


2.1 


2.5 


2.8 


2.9 


3.7 


3.3 


2.8 


2.2 



As between the sexes, absence on account of sickness is, with some 
exceptions, greater for girls than for boys. The differences, however, 
are so small that they can hardly be considered significant. The 



SICKNESS AMONG SCHOOL CHILDEEN. 



absence from causes other than sickness is greater for boys than for 
girls in practically all cases. Although the differences are not great, 
they persist in all months and therefore seem to indicate that causes 
other than sickness were responsible for a greater amount of ab- 
senteeism among boys than among girls. 

From the point of view of age, the younger group seems to lose 
more time because of sickness than the older group. The percent- 
ages of total possible days of attendance which were lost on account 



Percentages or Total Possible Days of School Attendance Which Were Lost on Account 
of Sickness and of Causes Other Than Sickness For Each Month of The School Year I9I9-20 
Bv Children in Certain Localities in Missouri 




Sepiember|Octob«r |Nov«mbar|Decembar Jeurm.n.r\f [February! Mtifcti | April | May 



5 8 



of sickness is greater for the younger group in practically all cases. 
The differences are large enough to be significant and suggest one of 
three things : that a larger number of cases of sickness occurred among 
the younger children, or that they recovered more slowly, or that they 
were kept at home for less serious illness or for a longer time after 
recovery than was the case with the older children. Unfortunately, 
the data available for this study were not in such a shape that the 
question could be settled as to which was actually the case. 

Absence from causes other than sickness seems to differ less for 
the two age groups than absence from sickness. For the year as a 
whole, the children of the older group were absent slightly more from 
causes other than sickness than were those of the younger group. 
As to the seasonal distribution of such absence, the younger group 
seems to have more absence in the first half of the year, but less in 
the last half. However, the differences are too slight to be signifi- 
cant; but since the tendency is so general and applies to all groups, 
it is worth noting. 



6 



SICKNESS AMONG SCHOOL CHILDREN. 



Figure I shows, for both sexes and all ages, the percentages of 
time lost from school because of sickness and of causes other than 
sickness for each month of the school year. 

The unusually high peak in February, 1920, is obviously due to 
the influenza epidemic. Of the days lost on account of sickness from 
known diseases in that month, 46 per cent were due to influenza, 
and 34 per cent of the cases of illness of known cause were due to 
influenza. Reference to Table IV will show that the percentages of 
days lost and of cases of influenza were not large except in January 
and February; the curve, therefore, approximates sickness in a 
normal year except for those months. 

In view of the consistently greater time lost on account of sickness 
by the younger of the two age groups, Table III was prepared to 
show the time lost on account of sickness and of causes other than 
sickness for children of each year of age from 6 to 16 years, inclusive, 
for the school session. The data are presented graphically in Figure 2. 

Table III. — Time lost from school on account of sickness and of other causes, by children 
each year of age from 6 to 16 years, inclusive, during the school year 1919-20, in certain 
localities in Missouri. 



Age in years. 


Total pos- 

Number of ^rl^'s 

children. : b «[ s ° c f h d £f 

attendance. 


Percentage 
of total 
possible 
days of 
school at- 
tendance 
lost on ac- 
count of 
sickness. 


Percentage 
of total 
possible 
days of 
school at- 
tendance 
lost on ac- 
count of 
other 
causes. 


All ages (6 to 16) : 


6, 099 666, 449 


5.6 


3.0 






6 


404 
627 
651 
745 
741 
754 
731 
618 
475 
261 
92 


49, 480 
65, 157 
67,605 
84, 764 
83,627 
84,982 
80,083 
62,246 
61, 040 
26,425 
9,040 


9.7 
8.6 
6.7 
6.1 
4.9 
4.0 
4.2 
4.0 
3.6 
4.9 
3.9 


3.8 


7 


3.0 


8 •. 


2.8 


9 


2.5 


10 


2.6 


11 


2.3 


12 


3.1 


13 


3.0 


14 


2.9 


15 


3.9 


16 


3.3 







The time lost from sickness shows no great variations nor any 
consistent trend from 11 to 16 years of age, but decreases considerably 
and consistently from 6 to 11 years. Absence from causes other than 
sickness shows no marked differences for the different ages. If any 
trend whatever is shown, it indicates increasing absence for the older 
children, but the items are irregular and the increasing trend is 
slight only. 

The specific diseases causing absence were reported in 2,326 
cases, resulting in 14,373 days' absence from school (see appended 
Tables VIII and IX). On the basis of these known cases, cer- 
tain computations were made as to the relative importance of 
certain diseases as a cause of absence in each month of the school 
year. Because of the fact that the influenza epidemic made certain 



SICKNESS AMONG SCHOOL CHILDREN. 



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SICKNESS AMONG SCHOOL CHILDREN. 



months of this school year exceptional, the cases of and the absences 
due to influenza were deducted from this total number, and the pro- 
portion of cases of and of days lost from all diseases, exclusive of 
influenza, were computed for each disease for each month of the school 
year. For example, absence because of sickness of known cause in 
March was 2,528 days; but of this total, 223 days were due to in- 
fluenza, leaving 2,305 days due to other known diseases. Of this 
total absence from known diseases, 543 days, or 23.6 per cent, were 
due to measles. Similar percentages were worked for other diseases 
and for each month to show the relative importance of certain 
diseases in causing absence from school at different seasons of the year 
after eliminating the abnormal condition resulting from influenza. 
Table IV shows the results of these computations. 

Table IV. — Percentages of total number of days lost from school on account of all illness 
of known cause (exclusive of influenza) , and percentages of total cases of illness ofknoivn 
cause (exclusive of influenza) due to certain diseases, among children 6 to 18 years of 
age, in certain localities in Missouri during 1919-20. 





Total 
school 
ye«r 


1019 


1920 


Disease. 


Sep- 
tember. 


Octo- 
ber. 


Novem- 
ber. 


Decem- 
ber. 


• an- 

uary. 


Febru 
ary. 


March. 


April. 


May. 



PERCENTAGE DUE TO EACH DISEASE. 



Days lost: 

All diseases (ex- 
clusive of in- 
fluenza) 

Colds 


100.0 

32. 5 
23.5 
12.8 

7. 5 
4.4 
3 6 
2.6 
2.3 
2.3 
.8 

i\ 2 

100.0 

57.0 

12.1 

10.3 

2.8 

1.1 

2.7 

2. } 

.7 

6.1 

.3 

_ 2 

i's 


100.0 
47.1 


100.0 
41.3 


100.0 
34.1 


100. 

50.8 

.8 
2.6 
19.7 
7.7 
3.2 
2.8 

1.8 

3.4 


100.0 

52.3 
.4 

16.2 
7.4 
4.4 
2.7 
2.3 
5.1 
2.2 


100.0 

33.0 
16.0 
11.6 
5.9 
5.4 
6.9 
3.1 
5.0 
3.0 
.9 
.7 
8.5 

100.0 

56. 1 

8.7 

10.1 

2.5 

1.7 

4.8 

3.1 

.8 

6.2 

.3 

.6 

5 1 


100.0 

33.1 
23.6 
19.7 
2.7 
3.6 
4.5 
2.2 
1.9 
1.8 

.9 
6.0 

100.0 

58. 9 
11.5 
13.8 

.7 

.7 

3.5 

2.8 

5.4 

.2 

4.5 


100.0 

10.7 

54.7 

15.3 

.7 

. 5 

.7 

2.5 

1.1 

2.2 

.7 

.2 

4.7 

100.0 

36. 

33.1 

13.5 

.3 

.3 

.8 

2.2 

1.1 

7.8 

.3 

4.0 


100.0 
15.6 




48.1 




14.3 
"2.T 


1.4 
30.1 
5.9 
2.3 
1.0 
1.4 
3.0 


1.4 

29.4 
7.8 
9.7 
3.5 
1.3 
3.3 
2.0 


13.6 


Scarlet fever .... 
Whooping cont'h 
Chicken pox .... 

Tonsillitis 

Pneumonia 

Toothache 

Diphtheria. . . 


.7 

6.6 

2.8 
2.1 








1.4 


Other diseases... 
Cases: 

All diseases (ex- 
clusive of in- 

Colds 


36.5 

100.0 
71.2 


13. 6 

100.0 
70.1 


7.5 

100.0 
61.0 


7.2 

100.0 

75.3 
.5 
3.0 
7.1 
.5 
2.5 
1.5 


7.0 

100.0 

72.6 

.3 

10.7 

2.2 

.9 

1.9 

2.2 

1.9 

3.8 


8.6 

100.0 
41.0 




27.7 




"""'fi.'s' 
3.2 


1.3 
9.1 
2.6 
1.3 
1.3 
1.3 
9.1 


1.6 
13.0 

i.e 

6.5 
2.4 


15.1 


Scarlet fever.. . . 
TV hoopiiv.' eoiirh 
Chicken pox. . . 
Tonsillitis 


2.4 
2.4 


Toothache 


9.0 

.8 


4.6 
1.0 


7.2 
.6 








.6 


Other diseases... 


16.1 


3.9 


4.1 


4.0 


3.5 


3.0 



PERCENTAGE OF TOTAL DAYS LOST FROM ILLNESS OF KNOWN CAUSE AND 
TOTAL CASES OF ILLNESS OF KNOWN CAUSE DUE TO INFLUENZA 



Days lost: 

Influenza. 
Cases: 

Influenza. 



17.7 


3.6 




2.1 


4.6 


IS. 1 


46.3 


8.8 


2 8 


11.2 


3.1 




1.6 


3.9 


12.2 


33.9 


3.8 


1.9 



SICKNESS AMONG SCHOOL CHILDREN. 



9 



It is a striking fact that colds were the greatest single assigned 
cause of absence in every month of the school year. The other infec- 
tious diseases are more or less seasonal in character; measles was an 
important cause of absence from February to May, scarlet fever from 
September to December. Seasonal variation was not such an out- 
standing fact in the other cases, but existed for most of the common 
infectious diseases. 

Children are more disposed to some diseases at certain ages, and 
therefore the relative importance of those diseases as causes of absence 
from school varies with age. In order to show this variation, Tables 
V and VI were prepared, showing by age groups the percentages of 
the total number of days lost from sickness of known cause which were 
due to certain diseases. Similar computations were made for the 
percentages of cases and the days lost per case of these diseases. 

Table V. — Percentage of days lost from diseases of known caiise and of cases of illness of 
known cause due to certain diseases among children in certain localities in Missouri, by 
age groups. 



Disease. 



Days lost. 



All ages 
(6 to 18). 



6 to 10 
years of 



11 to IS 

years of 

age. 



Cases. 



All ages 
(6 to 18). 



6 to 10 

years of 

age. 



11 to 18 

years of 



PERCENTAGE OF ALL ILLNESS FROM KNOWN CAUSE (EXCLUSIVE OF INFLUENZA) 
DUE TO CERTAIN DISEASES. 



All diseases (exclusive of influenza). 



Colds 

Measles 

Mumps 

Scarlet fever 

Whooping cough. 

Chicken pox 

Tonsillitis 

Toothache ,. 

Pneumonia 

Diphtheria 

Smallpox 

Other diseases 



100.0 

32.5 
23.5 
12.8 
7.5 
4.4 
3.6 
2.6 
2.3 
2.3 



100.0 

28.4 

28.6 

12.0 

8.2 

6.3 

4.2 

1.4 

1.6 

2.2 

.5 

.6 

6.0 



100.0 

41.0 

12.9 

14.5 

6.0 

.3 

2.5 

5.0 

3.8 

2.4 

1.4 

.4 

9.S 



100.0 

57.0 

12.1 

10.3 

2.8 

1.1 

2.7 

2.4 

6.1 

.7 

.3 

.2 

4.3 



100.0 

52.8 

16.7 

10.9 

3.2 

1.7 

3.5 

1.3 

5.0 

.7 

.2 

.2 

3! 8 



100.0 

63.2 
5.5 
9.5 
2.3 

.1 
1.4 
4.0 
7.8 
.7 
.4 
.1 
5.0 



PERCENTAGE OF ALL ILLNESS FROM KNOWN CAUSE DUE TO INFLUENZA. 



Influenza. 



17.7 


16.0 


21.0 


11.2 


10.5 



10 



SICKNESS AMONG SCHOOL CHILDREN. 



Table VI.- 



- Average number of days lost Jrom school per case of certain diseases among 
children in certain localities in Missouri, by age groups. 



Disease. 



All ages 
(6 to 18). 



6 to in 
years of 



11 to 18 

years of 

age. 



All diseases 

Whooping cough 

Pneumonia 

Diphtheria 

Scarlet fever 

Smallpox 

Measles 

Influenza 

Chicken pox 

Mumps 

Tonsillitis 

Colds 

Toothache 

Other diseases... 



6.2 

23.5 
19.2 
15.9 
15.1 
14.5 
11.1 
9.7 
7.8 
7.1 
6.2 
3.3 
2.2 
9.6 



24.1 

22.1 

14.0 

16.5 

14.3 

11.2 

10.5 

7.7 

7.1 

7.1 

3.5 

2.1 

10.2 



5.1 

9.5 
15.3 
17.8 
12.2 
15.0 
10.7 
8.8 
7.8 
7.1 
5.8 
3.0 
2.2 
8.9 



Figure 3 shows graphically the relative importance of these diseases 
as measured in days lost and in cases of illness among children of 
6 to 18 years of age, inclusive. Figure 4 shows the severity of cases 
of various diseases as measured in the average time lost from school 
per case. 

For the year as a whole, the children lost, on account of sickness, 
an average of 5.6 per cent of the days that school was in session. 
Assuming that this percentage of days of sickness is representative 
of the whole year, it means an average of slightly over 20 days of 
sickness per child per year. Boys were absent on account of sickness 
almost as much as girls, the difference being only 0.4 of 1 per cent, 
which, on an annual basis, would mean about 20 days of sickness for 
boys and about 21 for girls. 

The data presented here are, of course, insufficient to afford con- 
clusions of a general nature, but it is believed that they do suggest 
that the use of school records for obtaining facts as to disease inci- 
dence among children is practicable. Such facts, it is unnecessary 
to say, would be of great value, not only to those who are interested 
in epidemiology, but to school and health administrators. 



SICKNESS AMONG SCHOOL CHILDREN. 



11 



Table VII. — Number of children included in the study, total possible number of days of 
school attendance, and days absent on account of sickness and of causes other than sick- 
ness, by months, for the school year 1919-20, in certain localities in Missouri. 



Aee and sex. 



All ages: 

Both sexes- 
Number of children . . . 
Total possible days of 

school attendance . . . 
Days absent — Sickness 
Days absent — Other 

causes 

Boys- 
Number of children 

Total possible days of 

school attendance 

Days absent — Sickness 
Days absent— Other 

causes 

Girls- 
Number of children 

Total possible days of 

school attendance — 
Days absent — Sickness 
Days absent— Other 

causes 

6 to 10 years: 
Both sexes — 

Number of children 

Total possible days of 

school attendance 

Days absent — Sickness 
Days absent — Other 

causes 

Boys- 
Number of children . . . 
Total possible days of 

school attendance 

Days absent — Sickness . 
Days absent — Other 

causes 

Girls- 
Number of children 

Total possible days of 

school attendance 

Days absent— Sickness . 
Days absent— Other 

causes 

11 to 18 years: 
Both sexes- 
Number of children 

Total possible days of 

school attendance 

Days absent— Sickness . 
Days absent — Other 

causes 

Boys- 
Number of children 

Total possible days of 

school attendance 

Days absent — Sickness. 
Days absent — Other 

causes 

Girls- 
Number of children 

Total possible days of 

school attendance 

Days absent— Sickness . 
Days absent — Other 

causes 



Total 

school 

year. 



6, 130 

669, 214 
37, 368 

19, 802 

2,870 

325, 150 
17,442 

10, 555 

3,260 

344, 064 
19, 926 



3,173 

351, 313 
24, 413 

10, 078 

1,497 

170,611 
11, 352 

5,300 

1,676 

180, 702 
13, 061 

4,778 
2, 957 



Sept. Oct. Nov. Dec 



317, 901 
12, 955 

9,724 

1,373 

154, 539 
6,090 

5,255 

1,584 

163, 362 
6,865 

4,469 



2,701 

54, 020 
717 

1, 

1,332 

26, 640 
326 

583 

1,369 

27, 380 
391 

516 



28,420 
376 



623 
692 



13,840 
167 



303 
729 



14, 5S0 
209 



1, 280 

25,6(10 
341 

476 

640 

12, 800 
159 

280 

640 

12,800 
182 

196 



55, S60 
1,101 

1,402 

1,382 

27,640 
646 

769 

1,411 

28, 220 
755 



1,476 

29, 520 
884 

813 

720 

14, 400 

384 

460 

756 

15, 120 
500 



1,317 

26, 340 
517 



13,240 
262 

309 

655 

13, 100 
255 



57, 120 
2,422 



1,470 
1,413 



28, 260 
1,138 



744 
1,443 



28, S60 
1,284 



726 



30, 320 
1,634 



14, 860 
737 



400 
773 



15, 460 

897 



1,340 

26,800 
788 

683 

670 

13, 400 
401 

344 

670 

13,400 
387 

339 



2,920 

58, 400 
3,219 

1,915 

1,447 

28, 940 
1,396 

1,066 

1,473 

29, 460 
1,823 



1,542 

30, 840 
2,059 

1,035 

753 

15,060 
863 

567 

789 

15, 780 
1,196 

468 



1,378 

27, 560 
1,160 



694 



13, S80 
533 



13, 680 
627 

381 



3,340 

66, 700 
4,226 

2,094 

1,650 

33,000 
2,000 

1,111 

1, 

33, 700 
2,226 



36, 160 
2,724 

1,186 

885. 

17, 700 
1,305 

638 

923 

18, 460 
1,420 

548 

1,532 

30, 540 
1, 502 

908 

765 

15,300 
695 

473 

767 

15,240 
806 



60S 



1,923 

3S, 460 
5,347 

1,507 

946 

18,920 
2,649 

814 

977 

19, 540 
2,69S 

693 



1,685 

33, 700 
3,044 

1,395 

833 

16, 600 
1,579 

761 

852 

17, 040 
1,465 



Mar. Apr. May 



764 



5,494 



1,674 

2,801 

56, 244 
4,991 

1, 570 

1,322 

26, 576 
2,299 

800 

1,479 

29, 668 
2,692 

770 

2,547 

51, 521 
2, 433 

1, 

1,190 

24, 025 
1,034 

964 

1,357 

27, 496 
1,399 



1,513 



56,496 
4, 290 

1, 408 

1,375 

27,552 
2,065 

706 

1,446 

28, 944 
2,224 

702 

2,673 

53, 773 
2,140 

1,754 

1,249 

25,081 
964 

943 

1,424 

28, 692 
. 1, 177 



4,377 

86,920 
3,138 

2,320 

2,115 

41, 856 
1,346 

1,294 

2,262 

45,064 
1,792 

1,026 

2,229 

44,853 
2,108 

1,149 

1,091 

21, 703 

883 

612 

1,138 

23, 150 
1,225 

537 

2,148 

42, 067 
1, 030 

1,171 

1,024 

20, 153 
463 

682 

1,124 

21, 914 
567 



12 



SICKNESS AMONG SCHOOL CHILDREN. 



Table VIII. — Number of days lost from school on account of sickness of known cause 
and number of cases of known diseases among school children 6 to 18 years of age, in 
certain localities in Missouri during 1919-20. l 





Total 
school 
year. 


1919 


1920 


Disease. 


Septem- 
ber. 


Octo- 
ber. 


Novem- 
ber. 


Decem- 
ber. 


Janu- 
ary. 


Feb- 
ruary. 


March. 


April. 


May. 


Days lost: 

All known dis- 


14,373 

11,832 

2,541 

2,326 

2,065 
261 


98 

95 
3 

32 

31 

1 


356 
356 

77 

77 


793 

777 
16 

125 

123 
2 


1,176 

1,122 
54 

206 

198 
8 


1,764 

1,445 
319 

361 

317 
44 


4,008 

2,154 
1,854 

537 

355 
182 


2,528 

2.305 
223 

444 

427 
17 


2,533 

2,461 
72 

378 


1,117 


All known dis- 
eases (exclu- 
sive of influ- 


1,117 


Influenza 

Cases: 

All known dis- 


lfifi 


All known dis- 
eases (exclu- 
sive of in flu- 


371 166 




7 





1 Data given here are for only the small part of the total absence from sickness in which the specific dis- 
ease was reported. 



Table IX. — Number of days lost from school on account of sickness of known cause 
and number of cases of each known disease causing absence among children 6 to 18 years 
of age, in certain localities in Missouri during 1919-20. 1 



Disease. 



All known diseases 

All known diseases (exclusive of influenza) 

Influenza 

Cold 

Measles 

Mumps 

Scarlet fever 

Whooping cough 

Chicken pox 

Tonsillitis 

Toothache 

Pneumonia 

Diphtheria 

Smallpox 

Other diseases 



Days lost. 



All ages 
(6 to 18). 



14, 373 
11,832 

2,541 

3,843 

2,785 

1,512 

891 

516 

427 

305 

275 

269 

96 

58 

855 



6 to 10 
years of 



9,523 
8,001 

1,522 

2,273 

2,290 

955 

659 

506 

333 

113 

129 

177 

42 

43 

481 



11 to 18 

years of 

age. 



4,850 
3,831 

1,019 

1,570 

495 

557 

232 

10 

94 

192 

146 

92 

54 

15 

374 



Cases. 



All ages 
(6 to 18). 



2,326 
2,065 

261 

1,177 

251 

213 

59 

22 

55 

49 

126 

14 

6 

4 



6 to 10 

years of 

age. 



1,376 
1,231 

145 

650 

205 

134 

40 

21 

43 

16 

61 

8 

3 

3 

47 



11 to 18 

years of 



950 
834 

116 

527 

46 

79 

19 

1 

12 

33 

65 

6 

3 

1 

42 



1 Data given here are for only the small part of the total absence from sickness in which the specific dis- 
ease was reported. 



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